By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD
Feb. 23, 2022
Your staff may be giving away practice money through unauthorized write-offs. This can happen when they decide on their own to give a discount for an exam to a friend, or when they fail to check whether a third-party payer was accurate in its assessment that too much was charged for a service. Here is how to put in place systems in your office to prevent these kinds of unauthorized write-offs from occurring.
Every office makes adjustments to what is billed to patients. Many of these fall into the category called write-offs. A write-off is used by businesses seeking to account for unpaid loan obligations, unpaid receivables or losses on stored inventory.
An example of a write-off would be a patient who did not pay their bill and it appears that they will not pay their bill. Rather than let that bill continue to sit in the accounts receivable category requiring your staff (or billing company) to continue to act on the unpaid bill (e.g.: continue to bill, send to small claims court), at some point, you draw a line in the sand and declare the bill to be uncollectable and write-off the amount.
Another example would be when you give an influential person who sends many patients to your practice a special discount. You are not charging the full amount but are writing-off some of the fee.
A third example is when you give discounts on multiple-pair sales.
In all of these examples, the full fee is discounted. Most of the time a staff member is making this entry into your software. Any time there is an adjustment to fees, there is the possibility of mistakes. Mistakes come in two categories: intentional and unintentional. Unintentional mistakes are a training issue or a systems issue or both. Intentional mistakes are an ethical issue.
Ethical Issues Should Lead to Termination
Unintentional issues should lead to a change in training and/or a change in your systems.
The place to start is to make sure you know what is going on in your practice. The best way to do this and keep your staff’s performance ethical is to make sure staff knows you are looking. Randomly throughout the year audit a day of billing. Do this multiple times over the year. Randomly is the best way to do this. If you are predictable, then staff knows when the system can be beaten. When you are looking randomly, no one knows if today is the day the audit occurs.
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Start each audit by comparing the schedule to the ledger. Every patient seen should have an associated bill with the visit. With each bill there may be write-offs. Be sure to look both at what is billed as well as how much and why there was a write-off.
When you look, you will find mistakes. Make whatever changes are necessary to your billing systems to make sure that the mistake(s) you found never happens again.
By staying on top of your billing, you will get paid correctly. You will also keep your team performing ethically, and for those who may be tempted, by randomly auditing you will keep them on the straight and narrow. It’s worth the effort to make sure your staff is correctly billing and not giving away too much.
